PD25-08 PREDICTORS OF INDEX PERCUTANEOUS NEPHROLITHOTOMY CARE SETTING AND IMPACT ON PERIOPERATIVE OUTCOMES AND COST

Abstract

You have accessJournal of UrologyHealth Services Research: Value of Care: Cost and Outcomes Measures II (PD25)1 Sep 2021PD25-08 PREDICTORS OF INDEX PERCUTANEOUS NEPHROLITHOTOMY CARE SETTING AND IMPACT ON PERIOPERATIVE OUTCOMES AND COST William French, Quoc-Dien Trinh, Roger Sur, and David Friedlander William FrenchWilliam French More articles by this author , Quoc-Dien TrinhQuoc-Dien Trinh More articles by this author , Roger SurRoger Sur More articles by this author , and David FriedlanderDavid Friedlander More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002018.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Percutaneous nephrolithotomy (PCNL) is an appropriate treatment option for patients with a large renal stone burden or complex anatomy. Cost pressures and newer minimally invasive approaches have led to a migration away from the traditional inpatient care setting toward ambulatory surgical centers. However, it is unclear what clinical and non-clinical factors determine where patients receive their surgical care and whether perioperative outcomes and costs differ among these cohorts. We sought to identify predictors of index surgical care setting as well as perioperative outcomes and cost associated with these unique care settings following PCNL surgery. METHODS: All-payer data from the 2014 Healthcare Cost and Utilization Project (HCUP) State Databases from Florida (FL) and New York (NY) were used to identify all patients undergoing an index PCNL. Patient demographics, regional data, 30-day revisit/reoperation rates, and total index/30-day costs were determined. Multivariable logistic regression adjusted for facility clustering was utilized to identify predictors of index surgical care setting and 30-day revisit/reoperation, while gamma generalized linear regression was used to compare index/30-day costs. RESULTS: Of the 747 patients undergoing PCNL, 314 (42.0%) received care in the inpatient setting compared to 433 (58.0%) in the ambulatory care setting at an adjusted mean cost of $11,904.66 vs. $8,876.438 (p<0.001). Predictors of receiving care in the ambulatory care setting included gender (female vs. male: OR 0.49, 95% CI 0.34-0.72; p<0.001), fewer comorbidities (CCI ³2 vs. 0: OR 0.41, 95% CI 0.24-0.68; p=0.01), insurance status (Uninsured vs. private: OR 0.10, 95% CI 0.04-0.27; p<0.001), and rural vs. metropolitan care setting (OR 22.36, 95% CI 6.46-77.38; p<0.001). The 30-day adjusted revisit/reintervention rate for cases performed in the ambulatory vs. inpatient setting was comparable (22.4% vs. 16.2%, p=0.9). Mean cost attributable to a 30-day revisit was $6,918.13. CONCLUSIONS: We demonstrated that both clinical and non-clinical factors predict where patients undergo PCNL, with patients receiving care in the ambulatory setting experiencing dramatically lower costs but comparable 30-day perioperative outcomes. Our findings suggest that ambulatory-based PCNL offers significant cost savings without compromising 30-day outcomes in appropriately selected patients. Source of Funding: Quoc-Dien Trinh is supported by the Brigham Research Institute Fund to Sustain Research Excellence, the Bruce A. Beal and Robert L. Beal Surgical Fellowship, the Genentech Bio-Oncology Career Development Award from the Conquer Cancer Foundation of the American Society of Clinical Oncology, a Health Services Research pilot test grant from the Defense Health Agency, the Clay Hamlin Young Investigator Award from the Prostate Cancer Foundation, and an unrestricted educational grant from the Vattikuti Urology Institute. David F. Friedlander is supported by a National Institutes of Health T32 training grant © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e434-e435 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information William French More articles by this author Quoc-Dien Trinh More articles by this author Roger Sur More articles by this author David Friedlander More articles by this author Expand All Advertisement Loading ...